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A sad one and a happy one

Posted Jun 06 2009 12:06am
Remains orally intubated.  Unresponsive to noxious stimuli.  No pupillary response.  No gag or cough reflux.  Does not breathe over ventilator assisted respirations.  No spontaneous movements.  

This is how my charted started last night.  The man I was writing about was 59 years old.  How sad is that.  A little over a week ago he went in for routine surgery and then had a small stroke (of the blood clot variety).  He came to my hospital's rehab unit post-stroke and was there for a few hours before suffering a massive bleeding episode in his brain from the blood thinners they had put him on after his last stroke in hopes of preventing another one.  This all happened just as his family was coming in to visit him.  Needless to say unexpected and quite shocking for them.

We immediately called the organ donation center in hopes that the family would be willing to go that route due to the futility of his condition.  Unfortunately they were not willing.  In fact, they were so in shock they didn't speak more than a word or two to us for about the first 24 hours that he was with us.  Finally today they are beginning to open up and see the reality and gravity of the situation.  Code status has finally been addressed and he will not be tortured thru unnecessary attempts at bringing him back to life since he is practically brain dead already.

Such a shame at 59.  :(

Now, to end on a happy note.........my other patient was such a nice guy.  55 and in a rapid heart rhythm called atrial flutter.  His heart rate was 140-150's all weekend despite numerous attempts to control it.  Everytime we tried we ended up with either long pauses in his heart rate or dropping blood pressure.  Neither one a good thing!!

Today I was supposed to go home at my usual time of 7:15 am and after having him for 3 nights in a row wouldn't have known how he made out unless I called for an update (which I rarely do).  But thanks to 2 call outs I stayed until 11:15 (whoo hooo to 4 hours of time and a half!!!!) so I got to be there for half his day.

Today his day included a TEE (an internal heart ultrasound) and then a DC cardioversion (heart shock back into the right rhythm and rate).  His dayshift nurse (who also had had him all weekend) and I were nervously excited when he was wheeled back onto the floor to see what his rate & rhythm were...................YES NSR in the 80's.  I think we both jumped for joy!!!  What a nice outcome for this man.   Hopefully he'll stay NSR now and this will be it for awhile for him.  Home on a new med or two and that will be that.  With A flutter though I doubt it will be the last time we'll see him unfortunately.  Here's hoping though!!!!

Go to fullsize image    Atrial flutter rhythm picture

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